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Stockfleth E, Heppt MV, Bégeault N, Delarue A. Evaluating the Efficacy and Safety of 4% 5-Fluorouracil Cream in Patients with Actinic Keratosis: An Expert Opinion. Acta Derm Venereol 2023; 103:adv11954. [PMID: 37982726 PMCID: PMC10680462 DOI: 10.2340/actadv.v103.11954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/16/2023] [Indexed: 11/21/2023] Open
Abstract
Actinic keratosis is a lesion that develops in sun-exposed areas of the skin and is considered to be a precancerous condition or an early in situ squamous cell carcinoma. Treatment of actinic keratosis is important for reducing skin cancer risk, with treatment choice based on patient-, lesion- and treatment-related considerations. Of the topical treatments used for field-directed therapy, those containing 5-fluorouracil are among the most effective and widely prescribed. The most recently developed topical 5-fluorouracil preparation (Tolak®; Pierre Fabre, France) contains 4% 5-fluorouracil in an aqueous cream. This narrative review discusses data on 4% 5-fluorouracil cream to treat actinic keratosis, and provides the authors' expert opinion on issues associated with it use. The effect of the cream has been evaluated in phase 2 and 3 trials of adult patients with actinic keratosis on the face, ears or scalp. These trials included patients with severe baseline disease, defined by high lesion counts and large-size treatment fields, which possibly affected the proportion of patients who were able to achieve complete clearance. Other efficacy parameters (e.g. percentage change in lesion count, ≥ 75% clearance of lesions or clinically significant changes in validated severity scales) should also be assessed to fully evaluate 4% 5-fluorouracil treatment efficacy in these patients. Nevertheless, 4% 5-fluorouracil is associated with high efficacy, a low level of recurrence and a satisfactory safety profile.
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Affiliation(s)
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
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Lindholm V, Salmivuori M, Hahtola S, Kerttu Mäkelä, Pitkänen S, Isoherranen K. Ablative Fractional Laser Enhances Artificial or Natural Daylight Photodynamic Therapy of Actinic Field Cancerization: A Randomized and Investigator-initiated Half-side Comparative Study. Acta Derm Venereol 2023; 103:adv6579. [PMID: 37584092 PMCID: PMC10442926 DOI: 10.2340/actadv.v103.6579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/31/2023] [Indexed: 08/17/2023] Open
Abstract
Artificial daylight photodynamic therapy is a near-painless treatment for actinic keratoses, which can be performed indoors using a controlled light dose. Daylight photodynamic therapy is approved only for treatment of grade I-II actinic keratoses. The aim of this study was to evaluate whether fractional laser pre-treatment improves the outcomes of daylight photodynamic therapy for actinic keratoses of all grades. In addition, the study compared the outcomes of artificial and natural daylight photodynamic therapy. This randomized single-blinded split-side comparative study included 60 patients with ≥ 2 actinic keratoses of the head. Fractional laser pre-treatment was assigned randomly for actinic keratoses on 1 side of the head and, subsequently, the entire treatment area was treated with artificial or natural daylight photodynamic therapy. Fractional laser-mediated daylight photodynamic therapy achieved significantly higher complete clearance (50.0% vs 30.3%, p = 0.04), partial clearance (78.6% vs 50.0%, p < 0.01) and lesion-specific clearance (86.2% vs 70.2%, p < 0.01) than daylight photodynamic therapy alone at the 6-month follow-up. No significant differences were found in the outcomes of artificial vs natural daylight photodynamic therapy or grade I lesions vs grade II-III lesions. Thus, fractional laser pre-treatment appears to significantly increase the efficacy of artificial and natural daylight photodynamic therapy, and to be suitable for treatment of actinic keratoses of all grades.
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Affiliation(s)
- Vivian Lindholm
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland.
| | - Mari Salmivuori
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
| | - Sonja Hahtola
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
| | - Kerttu Mäkelä
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
| | - Sari Pitkänen
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
| | - Kirsi Isoherranen
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital and University of Helsinki, Meilahdentie 2, FIN-00250 Helsinki, Finland
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3
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Actinic keratosis (review of literature). BIOMEDICAL PHOTONICS 2022. [DOI: 10.24931/2413-9432-2022-11-1-37-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Actinic keratosis is an important medical and social problem, the correct diagnosis and treatment of which will help to avoid the development of invasive forms of cutaneous squamous cell carcinoma. With the further development of the early diagnosis of cancer, including skin cancer, the increase in human life expectancy, and the popularization of travel to exotic countries, the number of cases of actinic keratosis among the population will continue to grow. In this regard, it is important to discuss the causes and pathogenesis of the disease, the varied clinical picture of the disease, methods of non-invasive diagnostics, as well as methods of treatment, of which there are a great many in the treatment of actinic keratosis today. However, each of the methods has both advantages and disadvantages, and in the global trend towards a personalized approach to treatment, it is important to choose from the standpoint of evidence-based medicine the most suitable for each individual patient. Moreover, after treatment of actinic keratosis, relapses often occur, which are the result of insufficient diagnosis and the development of incorrect treatment tactics. The review article provides the clinical picture of actinic keratosis, diagnostic and therapeutic methods, and their comparison with each other in terms of efficacy and safety
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Garofalo V, Geraci F, Di Prete M, Lanna C, Lozzi F, Cosio T, Lambiase S, Gaeta Schumak R, Di Raimondo C, Diluvio L, Bianchi L, Campione E. Early clinical response to 5-fluorouracil 0.5% and salicylic acid 10% topical solution in the treatment of actinic keratoses of the head: an observational study. J DERMATOL TREAT 2022; 33:2664-2669. [PMID: 35435128 DOI: 10.1080/09546634.2022.2067817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Actinic keratosis is one of the most common dermatological disorders. A new topical solution, constituted by 0.5% 5-fluorouracil and 10% salicylic acid (Actikerall, Almirall) has been introduced in the treatment pipeline of non-hyperkeratotic actinic keratoses of the head and neck. PATIENTS AND METHODS We analyzed in an observational prospective clinical study the short-term treatment effectiveness of 5-fluorouracil and salicylic acid on face and scalp actinic keratoses of grade 1 and 2 of forty patients. Efficacy assessment was performed by clinical dermatological examination, collecting color photographs, calculating AKASI score, and by means of dermoscopy for each target lesion at every visit. RESULTS AKASI score decreased from an initial score of 3.3 to a final score of 0.9. At week 4, we were able to record a complete clearance of 50% of the treated lesions and a partial clearance of 28%. At the end of 12 weeks, 84% of the total lesions showed complete clearance, while 8% had partial clearance. CONCLUSIONS 5-fluorouracil and salicylic acid topical solution is effective in the treatment of mild to moderate actinic keratoses. In the future, further studies are needed to evaluate the chance of adjusting drug dosage according to patients' and actinic keratoses features.
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Affiliation(s)
- Virginia Garofalo
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Francesco Geraci
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Monia Di Prete
- Anatomic Pathology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy.,Anatomic Pathology, Santa Maria di Ca' Foncello Hospital, 31100 Treviso, Italy
| | - Caterina Lanna
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Flavia Lozzi
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Terenzio Cosio
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Sara Lambiase
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Ruslana Gaeta Schumak
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Cosimo Di Raimondo
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Laura Diluvio
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
| | - Elena Campione
- Dermatology Unit, University of Rome Tor Vergata, Via Montpellier, 1 00133 Rome, Italy
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Kalil CLPV, Reinehr CPH, Bakos RM. Short-Term Follow-Up of a Randomized Controlled Trial of 0.5% and 5% 5-Fluorouracil After Microneedling for Treatment of Facial Actinic Keratoses. Dermatol Surg 2022; 48:293-298. [PMID: 35125436 DOI: 10.1097/dss.0000000000003301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Topical 5-fluorouracil (5-FU) is used to treat actinic keratosis, although side effects limit treatment. Microneedling might be a tool for reducing treatment duration. OBJECTIVE To evaluate microneedling to promote 5-FU delivery at different concentrations (0.5% and 5%) for actinic keratoses (AKs) treatment. METHODS Forty-four patients with facial AKs subjected to 1.0 mm microneedling on 1 side of the face were randomized into 5% 5-FU or 0.5% 5-FU groups. Evaluations of efficacy and safety were conducted on days 21 and 111. RESULTS Forty-four patients aged 47 to 85 years were enrolled. Complete clearance of AKs was similar within groups for the side of the face treated with microneedling and 5-FU and the side treated with 5-FU alone in both the 5% and 0.5% 5-FU groups. Microneedling and 5% 5-FU was superior to microneedling and 0.5% 5-FU to reduce AKs (p = .025). Microneedling and 5% 5-FU resulted in fewer adverse effects than 5% 5-FU alone (p = .011). CONCLUSION Topical 5% and 0.5% 5-FU delivery for 3 days after microneedling was effective for treating facial AKs and equivalent to 5% and 0.5% 5-FU alone for 15 days after 3 months of follow-up. Microneedling may potentiate 5-FU treatment, reducing treatment time without losing efficacy.
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Affiliation(s)
- Célia Luiza Petersen Vitello Kalil
- All authors are affiliated with the Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Topical Pharmacotherapy for Actinic Keratoses in Older Adults. Drugs Aging 2022; 39:143-152. [PMID: 35156172 PMCID: PMC8873057 DOI: 10.1007/s40266-022-00919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/21/2022]
Abstract
Actinic keratosis is caused by excessive lifetime sun exposure. It must be treated, regardless of thickness, because it is the biologic precursor of invasive squamous cell carcinoma, a potentially deadly malignancy. Physical ablative techniques such as cryotherapy, lasers, and curettage are the most used treatments for isolated lesions. Multiple lesions are treated with topical drugs, chemical peelings, and physical techniques. Drug preparations containing diclofenac plus hyaluronate, aminolevulinic acid, and methyl aminolevulinate and different concentrations of imiquimod and 5-fluorouracil are approved for this clinical indication. All treatments have a good profile of efficacy and tolerability although there are relevant differences in the clearance rate, tolerability, and type and frequency of adverse effects. In addition, they have very different mechanisms of action and treatment protocols. No differences in the efficacy and tolerability were found in older patients compared with younger patients, therefore no dose adjustments are needed. That said, older patients often need to be motivated to treat actinic keratoses and a careful attention to expectations, needs, and preferences should be used to obtain the maximal adherence and prevent treatment failure. This goal can be achieved with a careful evaluation not only of published efficacy, toxicity, and tolerability data but also of practical topics such as the frequency of daily applications, the overall duration of therapy, and the need for a caregiver. Finally, particular attention must be paid in the case of frail patients and immunosuppressed patients.
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Intensity of Local Skin Reactions During 5-Fluorouracil Treatment Related to the Number of Actinic Keratosis Lesions: A Post Hoc, Exploratory Analysis. Dermatol Ther (Heidelb) 2021; 12:467-479. [PMID: 34954811 PMCID: PMC8850465 DOI: 10.1007/s13555-021-00668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/10/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Actinic keratoses (AK) are epithelial lesions caused by chronic skin exposure to ultraviolet light that can progress into squamous cell carcinoma. Although several treatments are effective, they are associated with severe skin reactions, which might be related to the extent of the disease. This study aimed to examine the relationship between the severity of local skin reactions during treatment with 5-fluorouracil 4% cream and the number of AK lesions at baseline. METHODS This post hoc analysis pooled data from two multicentre randomised phase III studies (HD-FUP3B-048, HD-FUP3B-049) in patients with AK treated with topical 5-fluorouracil 4% once daily (OD) or 5% twice daily (BID) for 4 weeks. First, we compared the severity, assessed using a numerical rating scale, of the local skin reactions between 5-fluorouracil 4% and 5%. Then, we investigated the relationship between the number of lesions at baseline and severe skin reactions with 5-fluorouracil 4% OD. RESULTS Safety data were included from 397 patients who had received 5-fluorouracil 4% (348 in study HD-FUP3B-048, 49 in study HD-FUP3B-049) OD and 342 (HD-FUP3B-048) who had received 5-fluorouracil 5% BID. For most skin reactions, severe ones were more common in patients treated with 5-fluorouracil 5% cream BID than in those treated with 5-fluorouracil 4% cream OD (P < 0.05). With 5-fluorouracil 4% OD, the incidence of severe erythema was significantly higher in patients with at least 10 lesions (46%) than in patients with 5-10 lesions (28%; P < 0.001). Similar results were observed for the other local skin reactions. CONCLUSION Treatment with 5-fluorouracil 4% cream OD was associated with less severe local skin reactions than 5-fluorouracil 5% BID. The number of AK lesions at baseline seems to have predictive value regarding the severity of local skin reactions that appear during treatment.
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Tai F, Shah M, Pon K, Alavi A. Laser Resurfacing Monotherapy for the Treatment of Actinic Keratosis. J Cutan Med Surg 2021; 25:634-642. [PMID: 34213956 DOI: 10.1177/12034754211027515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treating actinic keratosis (AK) and photodamaged skin is critical to reduce the risk of progression to skin cancer. Laser resurfacing for AK treatment is available as either lesion-directed or field therapy. Laser resurfacing removes the superficial epidermis and dermis containing actinic damage, promoting re-epithelialization of healthy skin. Although laser resurfacing has been explored as a modality for AK treatment in the literature, studies summarizing its efficacy in the treatment of AK are lacking. This review summarizes existing research on laser resurfacing as a monotherapy for AK treatment, highlighting the various laser resurfacing modalities available for AK treatment as well as their complications and efficacy in comparison to other therapies. Despite longer healing time, fully ablative laser resurfacing, including carbon dioxide and erbium-doped yttrium aluminum garnet were found to be more effective for AK treatment than fractional ablative techniques. Although some studies suggest laser resurfacing monotherapy as less efficacious than photodynamic therapy, and equally effective to 5-fluorouracil and 30% trichloroacetic acid, clinical trials of larger sample size are required to establish stronger evidence-based conclusions. Moreover, laser resurfacing used as lesion-directed therapy, as opposed to the usual field-therapy, requires further investigation.
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Affiliation(s)
- Felicia Tai
- 793812366 Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Monica Shah
- 793812366 Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Kucy Pon
- 71545 Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, ON, Canada
| | - Afsaneh Alavi
- Department of Medicine, University of Toronto, ON, Canada.,Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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Plachouri KM, Mulita F, Grafanaki K, Georgiou S. Remission of genital and generalised extragenital lichen sclerosus et atrophicus under pulse therapy with intravenous steroids. BMJ Case Rep 2021; 14:14/4/e241900. [PMID: 33931426 PMCID: PMC8098760 DOI: 10.1136/bcr-2021-241900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
| | - Francesk Mulita
- Department of General Surgery, University General Hospital of Patras Holy Mary the Help, Patras, Greece
| | - Katerina Grafanaki
- Dermatology Department, University General Hospital of Patras, Patras, Greece
| | - Sophia Georgiou
- Dermatology Department, University General Hospital of Patras, Patras, Greece
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Sola-Ortigosa J, Muñoz-Santos C, Otzet-Gramunt I, Masat-Ticó T, Isidro-Ortega J, Guilabert A. The Usefulness of Teledermatology in Monitoring the Efficacy and Safety of a Topical Treatment for Actinic Keratosis. J Invest Dermatol 2021; 141:1837-1839.e12. [PMID: 33453263 DOI: 10.1016/j.jid.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/14/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Joaquin Sola-Ortigosa
- Department of Dermatology, Fundació Privada Hospital Asil de Granollers, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
| | - Carlos Muñoz-Santos
- Department of Dermatology, Fundació Privada Hospital Asil de Granollers, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Isabel Otzet-Gramunt
- Primary Care Physicians, Members of the Grup d'Estudi de Teledermatologia del Vallès Oriental, Barcelona, Spain
| | - Teresa Masat-Ticó
- Primary Care Physicians, Members of the Grup d'Estudi de Teledermatologia del Vallès Oriental, Barcelona, Spain
| | - Joan Isidro-Ortega
- Primary Care Physicians, Members of the Grup d'Estudi de Teledermatologia del Vallès Oriental, Barcelona, Spain
| | - Antonio Guilabert
- Department of Dermatology, Fundació Privada Hospital Asil de Granollers, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
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Affiliation(s)
- Catarina Estevinho
- Obstetrics and Gynaecology, Centro Hospitalar Tâmega e Sousa EPE, Guilhufe, Porto, Portugal
| | - Elisa Soares
- Obstetrics and Gynaecology, Centro Hospitalar Tâmega e Sousa EPE, Guilhufe, Porto, Portugal
| | - Ana Portela Carvalho
- Obstetrics and Gynaecology, Centro Hospitalar Tâmega e Sousa EPE, Guilhufe, Porto, Portugal
| | - Fernanda Costa
- Obstetrics and Gynaecology, Centro Hospitalar Tâmega e Sousa EPE, Guilhufe, Porto, Portugal
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12
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Virtual consultation for actinic keratosis. BJGP Open 2020; 4:bjgpopen20X101126. [PMID: 32967844 PMCID: PMC7606138 DOI: 10.3399/bjgpopen20x101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/16/2020] [Indexed: 11/05/2022] Open
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Segura S, Gadea A, Nonell L, Andrades E, Sánchez S, Pujol R, Hernández-Muñoz I, Toll A. Identification of differentially expressed genes in actinic keratosis samples treated with ingenol mebutate gel. PLoS One 2020; 15:e0232146. [PMID: 32413042 PMCID: PMC7228095 DOI: 10.1371/journal.pone.0232146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Actinic keratosis is a common skin disease that may progress to invasive squamous cell carcinoma if left untreated. Ingenol mebutate has demonstrated efficacy in field treatment of actinic keratosis. However, molecular mechanisms on ingenol mebutate response are not yet fully understood. In this study, we evaluated the gene expression profiles of actinic keratosis lesions before and after treatment with ingenol mebutate using microarray technology. Actinic keratoses on face/scalp of 15 immunocompetent patients were identified and evaluated after treatment with topical ingenol mebutate gel 0.015%, applied once daily for 3 consecutive days. Diagnostic and clearance of lesions was determined by clinical, dermoscopic, and reflectance confocal microscopy criteria. Lesional and non-lesional skin biopsies were subjected to gene expression analysis profiled by Affymetrix microarray. Differentially expressed genes were identified, and enrichment analyses were performed using STRING database. At 8 weeks post-treatment, 60% of patients responded to ingenol mebutate therapy, achieving complete clearance in 40% of cases. A total of 128 differentially expressed genes were identified following treatment, and downregulated genes (114 of 128) revealed changes in pathways important to epidermal development, keratinocyte differentiation and cornification. In responder patients, 388 downregulated genes (of 450 differentially expressed genes) were also involved in development/differentiation of the epidermis, and immune system-related pathways, such as cytokine and interleukin signaling. Cluster analysis revealed two relevant clusters showing upregulated profile patterns in pre-treatment actinic keratoses of responders, as compared to non-responders. Again, differentially expressed genes were mainly associated with cornification, keratinization and keratinocyte differentiation. Overall, the present study provides insight into the gene expression profile of actinic keratoses after treatment with ingenol mebutate, as well as identification of genetic signatures that could predict treatment response.
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Affiliation(s)
- Sonia Segura
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Alejandra Gadea
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centre National de la Recherche Scientifique (CNRS), Centre de Recherche Paul Pascal (CRPP), Université de Bordeaux, Pessac, France
| | - Lara Nonell
- MARGenomics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Evelyn Andrades
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Silvia Sánchez
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ramon Pujol
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Inmaculada Hernández-Muñoz
- Group of Inflamatory and Neoplasic Dermatological Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Agustí Toll
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Dianzani C, Conforti C, Giuffrida R, Corneli P, di Meo N, Farinazzo E, Moret A, Magaton Rizzi G, Zalaudek I. Current therapies for actinic keratosis. Int J Dermatol 2020; 59:677-684. [PMID: 32012240 DOI: 10.1111/ijd.14767] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 12/31/2019] [Accepted: 12/31/2019] [Indexed: 12/15/2022]
Abstract
Actinic keratosis (AK) is a very common skin disease caused by chronic sun damage, which in 75% of cases arises on chronically sun-exposed areas, such as face, scalp, neck, hands, and forearms. AKs must be considered an early squamous cell carcinoma (SCC) for their probable progression into invasive SCC. For this reason, all AK should be treated, and clinical follow-up is recommended. The aims of treatment are: (i) to clinically eradicate evident and subclinical lesions, (ii) to prevent their evolution into SCC, and (iii) to reduce the number of relapses. Among available treatments, it is possible to distinguish lesion-directed therapies and field-directed therapies. Lesion-directed treatments include: (i) cryotherapy; (ii) laser therapy; (iii) surgery; and (iv) curettage. Whereas, field-directed treatments are: (i) 5-fluorouracil (5-FU); (ii) diclofenac 3% gel; (iii) chemical peeling; (iv) imiquimod; and (v) photodynamic therapy (PDT). Prevention plays an important role in the treatment of AKs, and it is based on the continuous use of sunscreen and protective clothing. This review shows different types of available treatments and describes the characteristics and benefits of each medication, underlining the best choice.
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Affiliation(s)
- Caterina Dianzani
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Claudio Conforti
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Paola Corneli
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Nicola di Meo
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Eleonora Farinazzo
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Anna Moret
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
| | | | - Iris Zalaudek
- Department of Dermatology, Maggiore Hospital, University of Trieste, Trieste, Italy
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Abramova TV, Murakhovskaya EK, Kovaleva YP. Actinic keratosis: аctual view. VESTNIK DERMATOLOGII I VENEROLOGII 2020. [DOI: 10.25208/0042-4609-2019-95-6-5-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- T. V. Abramova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - E. K. Murakhovskaya
- Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation
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16
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Reinehr CPH, Bakos RM. Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects. An Bras Dermatol 2019; 94:637-657. [PMID: 31789244 PMCID: PMC6939186 DOI: 10.1016/j.abd.2019.10.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023] Open
Abstract
Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.
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Affiliation(s)
| | - Renato Marchiori Bakos
- Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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17
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Ruiz ES, Schmults CD. Risk Stratification: Should All Actinic Keratoses in All Patients Be Treated? CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0217-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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18
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Goldenberg G. Treatment considerations in actinic keratosis. J Eur Acad Dermatol Venereol 2017; 31 Suppl 2:12-16. [PMID: 28263018 DOI: 10.1111/jdv.14152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/31/2017] [Indexed: 11/29/2022]
Abstract
The chronic skin condition actinic keratosis (AK) is characterized by the formation of keratotic lesions of variable thickness that are poorly delimited. AK occurs on areas of the skin that have had long-term exposure to the sun or UV radiation. Although AKs may regress, they usually persist and can progress to squamous cell carcinoma (SCC). Clinicians are unable to predict which AKs will progress; therefore, both clinically visible lesions and subclinical, non-visible (i.e. the entire area affected by AK/field cancerization) should be treated. AK treatment options include lesion-directed therapies that target specific AK lesions and field-directed therapies that target multiple clinical lesions and the underlying field damage. This article reviews currently available treatment options in AK, with a focus on patient-applied field therapies, and their suitability according to specific disease characteristics and patient needs. Choice of treatment in AK depends on lesion-, patient- and treatment-related factors and should be individualized. Considerations when choosing a therapy include site of application, treatment duration, surface area of application, tolerability profiles and implications on adherence. Field-directed therapies treat clinical and subclinical damage (i.e. the entire area affected by AK), achieve high rates of sustained clearance of AKs and may reduce the risk of progression to SCC. There is a clear need for field therapies with short duration of treatment and predictable, short-lived, mild local skin reactions that can be used over a large surface area. Therapies with shorter and simpler treatment courses are often associated with better adherence than treatments with longer courses. These may, therefore, represent more appropriate choices in patients for whom convenience and/or adherence are an issue.
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Affiliation(s)
- G Goldenberg
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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19
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Bower C. Field treatment of actinic keratosis on the scalp. Br J Dermatol 2017; 176:1425-1426. [DOI: 10.1111/bjd.15579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. Bower
- Department of Dermatology; Royal Devon & Exeter Hospital; Gladstone Road Exeter EX1 2ED U.K
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20
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Calzavara-Pinton P, Hædersdal M, Barber K, Basset-Seguin N, Del Pino Flores ME, Foley P, Galimberti G, Gerritsen R, Gilaberte Y, Ibbotson S, Peris K, Sapra S, Sotiriou E, Torezan L, Ulrich C, Guillemot J, Hendrich J, Szeimies RM. Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT. J Cutan Med Surg 2017; 21:3S-16S. [PMID: 28406719 DOI: 10.1177/1203475417702994] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK). Objectives: To develop a structured consensus statement on the diagnosis, classification, and practical management of AK based on up-to-date information. Methods: A systematic review of AK clinical guidelines was conducted. This informed the preparation of a 3-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options. Results: The systematic review found deficiencies in current guidelines with respect to new AK treatments such as ingenol mebutate and dl-PDT. The Delphi panel established consensus statements across definition, diagnosis, classification, and management of AK. While the diagnosis of AK essentially rests on the nature of lesions, treatment decisions are based on several clinical and nonclinical patient factors and diverse environmental attributes. Participants agreed on ranked treatment preferences for the management of AK and on classifying AK in 3 clinical situations: isolated AK lesions requiring lesion-directed treatment, multiple lesions within a small field, and multiple lesions within a large field, both requiring specific treatment approaches. Different AK treatment options were discussed for each clinical situation. Conclusions: The results provide practical recommendations for the treatment of AK, which are readily transferable to clinical practice, and incorporate the physician’s clinical judgement. The structured consensus statement positioned dl-PDT as a valuable option for patients with multiple AKs in small or large fields.
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Affiliation(s)
| | - Merete Hædersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirk Barber
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Basset-Seguin
- Department of Dermatology, Hospital Saint-Louis, Université Paris 7, Paris, France
| | | | - Peter Foley
- Department of Medicine (Dermatology), University of Melbourne; St Vincent’s Hospital Melbourne, Fitzroy, and Skin & Cancer Foundation, Carlton, Australia
| | - Gaston Galimberti
- Department of Dermatology, School of Medicine, Hospital Italiano, Buenos Aires, Argentina
| | - Rianne Gerritsen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Sally Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Ketty Peris
- Catholic University of Rome, Fondazione Policlinico Gemelli, Rome, Italy
| | - Sheetal Sapra
- Institute of Cosmetic and Laser Surgery, Oakville, Ontario, Canada
| | - Elena Sotiriou
- First Dermatology Department, Aristotle University, Thessaloniki, Greece
| | - Luis Torezan
- Hospital das Clinicas Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
| | | | - Jonathan Guillemot
- Amaris, London, UK
- Universidad San Francisco de Quito USFQ, Escuela de Medicina, Quito, Ecuador
| | | | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Vest Hospital, Academic Teaching Hospital University of Bochum, Recklinghausen, Germany
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21
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[Current guidelines in dermatology : A selection of clinically relevant recommendations]. Hautarzt 2016; 67:391-6. [PMID: 27052528 DOI: 10.1007/s00105-016-3783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Guidelines are systematically developed decision aids for specific medical conditions. The German Dermatological Society, together with the German Professional Association of Dermatologists, takes the lead in the development of the guidelines for dermatology in Germany. In addition to national guidelines, European and international guidelines also exist. In 2014 and 2015 German guidelines on the following topics were newly developed or updated: cutaneous larva migrans, anticoagulation during dermatosurgery, pemphigus vulgaris and bullous pemphigoids, Mohs surgery, anal dysplasia, and anal carcinoma in HIV-infected patients. European guidelines on psoriasis vulgaris and hand eczema were updated among others. An international guideline on actinic keratosis was also published. The guidelines are available at www.awmf.org and www.euroderm.org .
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22
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Pellacani G, Neri L, Longo C. Comment to: 'Evidence and consensus based (S3) Guidelines for the Treatment of Actinic Keratosis'. J Eur Acad Dermatol Venereol 2015; 30:e114. [PMID: 26403096 DOI: 10.1111/jdv.13355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G Pellacani
- Unit of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.
| | - L Neri
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, Arcispedale S Maria Nuova IRCCS, Reggio Emilia, Italy
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